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Lazarus JV, Ortiz A, Tyrovolas S, Fernández E, Guy D, White TM, Ma R, Hay SI, Naghavi M, Soriano JB. A GBD 2019 study of health and Sustainable Development Goal gains and forecasts to 2030 in Spain. Sci Rep 2022; 12:21154. [PMID: 36477107 PMCID: PMC9729199 DOI: 10.1038/s41598-022-24719-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 11/18/2022] [Indexed: 12/12/2022] Open
Abstract
This study aimed to report mortality, risk factors, and burden of diseases in Spain. The Global Burden of Disease, Injuries, and Risk Factors 2019 estimates the burden due to 369 diseases, injuries, and impairments and 87 risk factors and risk factor combinations. Here, we detail the updated Spain 1990-2019 burden of disease estimates and project certain metrics up to 2030. In 2019, leading causes of death were ischaemic heart disease, stroke, chronic obstructive pulmonary disease, Alzheimer's disease, and lung cancer. Main causes of disability adjusted life years (DALYs) were ischaemic heart disease, diabetes, lung cancer, low back pain, and stroke. Leading DALYs risk factors included smoking, high body mass index, and high fasting plasma glucose. Spain scored 74/100 among all health-related Sustainable Development Goals (SDGs) indicators, ranking 20 of 195 countries and territories. We forecasted that by 2030, Spain would outpace Japan, the United States, and the European Union. Behavioural risk factors, such as smoking and poor diet, and environmental factors added a significant burden to the Spanish population's health in 2019. Monitoring these trends, particularly in light of COVID-19, is essential to prioritise interventions that will reduce the future burden of disease to meet population health and SDG commitments.
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Affiliation(s)
- Jeffrey V. Lazarus
- grid.5841.80000 0004 1937 0247Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Calle del Rossellón 171, 08036 Barcelona, Spain ,grid.5841.80000 0004 1937 0247Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
| | - Alberto Ortiz
- grid.5515.40000000119578126Department of Medicine, Universidad Autónoma de Madrid, Madrid, Spain ,grid.411171.30000 0004 0425 3881Department of Nephrology and Hypertension, The Institute for Health Research Foundation Jiménez Díaz University Hospital, Madrid, Spain
| | - Stefanos Tyrovolas
- St. John of God Health Park, San Juan de Dios Sanitary Park, Sant Boi de Llobregat, Spain ,Biomedical Research Networking Center for Mental Health Network (CiberSAM), Madrid, Spain
| | - Esteve Fernández
- grid.417656.7Tobacco Control Unit, Catalan Institute of Oncology- ICO, WHO Collaborating Centre for Tobacco Control, L’Hospitalet de Llobregat, Barcelona, Spain ,grid.417656.7Tobacco Control Research Group, Bellvitge Biomedical Research Institute -IDIBELL, L’Hospitalet de Llobregat, Barcelona, Spain ,grid.5841.80000 0004 1937 0247Department of Clinical Sciences, School of Medicine and Health Sciences, Campus of Bellvitge, University of Barcelona, Barcelona, Spain ,grid.413448.e0000 0000 9314 1427Center for Biomedical Research in Respiratory Diseases Network (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
| | - Danielle Guy
- grid.5841.80000 0004 1937 0247Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Calle del Rossellón 171, 08036 Barcelona, Spain
| | - Trenton M. White
- grid.5841.80000 0004 1937 0247Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Calle del Rossellón 171, 08036 Barcelona, Spain
| | - Rui Ma
- grid.34477.330000000122986657Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA USA
| | - Simon I. Hay
- grid.34477.330000000122986657Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA USA ,grid.34477.330000000122986657Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA USA
| | - Mohsen Naghavi
- grid.34477.330000000122986657Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA USA ,grid.34477.330000000122986657Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA USA
| | - Joan B. Soriano
- grid.413448.e0000 0000 9314 1427Center for Biomedical Research in Respiratory Diseases Network (CIBERES), Instituto de Salud Carlos III, Madrid, Spain ,grid.411251.20000 0004 1767 647XHospital Universitario de la Princesa, Universidad Autónoma de Madrid, Madrid, Spain
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García-Rudolph A, Cegarra B, Saurí J, Opisso E, Tormos JM, Bernabeu M. [The impact of educational level on cognitive assessments in young patients admitted to rehabilitation after ischaemic stroke]. Rehabilitacion (Madr) 2021; 56:264-273. [PMID: 34702593 DOI: 10.1016/j.rh.2021.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 09/20/2021] [Accepted: 09/21/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION AND OBJECTIVE We propose to assess the impact of educational level on cognitive tests at admission and discharge after a period of cognitive rehabilitation in young patients after ischaemic stroke. MATERIALS AND METHODS We considered secondary and higher education (group A) and less than 6 years of formal education (group B). We compared A and B using χ2 and Kruskal-Wallis. We studied A and B as predictors of verbal and working memory at discharge. Verbal and working memories were assessed at admission and discharge using Rey Auditory Verbal Learning Test (RAVLT) and DIGITS of the Barcelona Test respectively. RESULTS We analysed n=277 patients (55% belonging to A, mean age of 51 years) admitted to a specialised centre in Spain between 2009 and 2019. We found significant differences (P<.05) at admission, all in favour of A in the assessments of attention, inhibition, visuoperception, visuoconstruction, verbal fluency and comprehension. In DIGITS and RAVLT-learning we found differences at admission. In Digits and RAVLT-recognition we found differences at discharge, all in favour of A. We found no differences in age, severity, time at admission, or length of stay in hospital. Nor did we find differences in cognitive gains or treatment efficiency in memory tests. The groups A and B did not predict RAVLT (R2=.53) or DIGITS (R2=.48). CONCLUSIONS A scores better in 63% of tests at admission and in 75% of tests at discharge, A and B are similar in gains and efficiency on memory tests.
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Affiliation(s)
- A García-Rudolph
- Recerca i Innovació Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Badalona, Barcelona, España; Universitat Autònoma de Barcelona, Bellaterra, Barcelona, España; Fundació Institut d'Investigació en Ciències de la Salut, Germans Trias i Pujol, Badalona, Barcelona, España
| | - B Cegarra
- Recerca i Innovació Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Badalona, Barcelona, España; Universitat Autònoma de Barcelona, Bellaterra, Barcelona, España; Fundació Institut d'Investigació en Ciències de la Salut, Germans Trias i Pujol, Badalona, Barcelona, España; Universitat de Barcelona, Barcelona, España.
| | - J Saurí
- Recerca i Innovació Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Badalona, Barcelona, España; Universitat Autònoma de Barcelona, Bellaterra, Barcelona, España; Fundació Institut d'Investigació en Ciències de la Salut, Germans Trias i Pujol, Badalona, Barcelona, España
| | - E Opisso
- Recerca i Innovació Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Badalona, Barcelona, España; Universitat Autònoma de Barcelona, Bellaterra, Barcelona, España; Fundació Institut d'Investigació en Ciències de la Salut, Germans Trias i Pujol, Badalona, Barcelona, España
| | - J M Tormos
- Recerca i Innovació Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Badalona, Barcelona, España; Universitat Autònoma de Barcelona, Bellaterra, Barcelona, España; Fundació Institut d'Investigació en Ciències de la Salut, Germans Trias i Pujol, Badalona, Barcelona, España
| | - M Bernabeu
- Recerca i Innovació Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Badalona, Barcelona, España; Universitat Autònoma de Barcelona, Bellaterra, Barcelona, España; Fundació Institut d'Investigació en Ciències de la Salut, Germans Trias i Pujol, Badalona, Barcelona, España
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Investigating the Relationship between Stress and Self-Rated Health during the Financial Crisis and Recession in 2008: The Mediating Role of Job Satisfaction and Social Support in Spain. J Clin Med 2021; 10:jcm10071463. [PMID: 33918170 PMCID: PMC8038162 DOI: 10.3390/jcm10071463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 03/19/2021] [Accepted: 03/30/2021] [Indexed: 11/30/2022] Open
Abstract
Background: the 2008 financial crisis and subsequent recession had a strong impact on employment and certain health indicators, such as mental health. Many studies carried out with diverse samples attest to the negative influence of stress on health. However, few studies focus on stress and self-rated health among the Spanish workforce, or analyse which variables can act as a buffer against the negative effects of stress on self-perceived health. Aim: to analyse the mediator role of social support and job satisfaction in the relationship between work-related stress and self-rated health among the Spanish working population between 2006 and 2017. Method: repeated cross-sectional study using Spanish Surveys from 2006 to 2017, a total of 32.105 participants (47.4% women) aged 16 years and over (M = 42.3, SD = 10.7) answered a series of questions about work-related stress (PV), self-rated health (CV), job satisfaction, and social support (mediator variables) through the National Health Survey (NHS) prevalences of work-related stress, self-rated health, job satisfaction, and social support were calculated (standardised by age). We performed mediation/moderation analysis with Macro Process for SPSS to analyse the role of social support and job satisfaction in the relationship between self-rated health and work-related stress among the Spanish working population. Results: three mediation analyses were conducted, one for each time point in the study period. The results revealed a significant direct association between stress and job satisfaction. In the 2006 model, both job satisfaction and social support acted as mediators between stress and self-rated health, while in the 2011 and 2017 models, only job satisfaction acted as a mediator. The data reveal that the working population in Spain has a good capacity for resilience, since no drop in health indicators was observed. Conclusion: following the economic recession, employment has partially recovered. However, social and employment policies are required to help the population face the recent situation triggered by the Coronavirus crisis.
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Borra C, Pons-Pons J, Vilar-Rodríguez M. Austerity, healthcare provision, and health outcomes in Spain. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2020; 21:409-423. [PMID: 31853673 DOI: 10.1007/s10198-019-01141-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 11/25/2019] [Indexed: 06/10/2023]
Abstract
The recession that started in the United States in December 2007 has had a significant impact on the Spanish economy through a large increase in the unemployment rate and a long recession which led to tough austerity measures imposed on public finances. Taking advantage of this quasi-natural experiment, we use data from the Spanish Ministry of Health from 1996 to 2015 to provide novel causal evidence on the short-term impact of changes in healthcare provision and regulations on health outcomes. The fact that regional governments have discretionary powers in deciding healthcare budgets and that austerity measures have not been implemented uniformly across Spain helps isolate the impact of these policy changes on health indicators of the Spanish population. Using Ruhm's (Q J Econ 115(2):617-650, 2000) fixed effects model, we find that medical staff and hospital bed reductions account for a significant increase in mortality rates from circulatory diseases and external causes, but not from other causes of death. Similarly, mortality rates do not seem to be robustly affected by the 2012 changes in retirees' pharmaceutical co-payments and access restrictions for illegal immigrants. Our results are robust to changes in model specification and sample selection and are primarily driven by accidental and emergency deaths rather than in-hospital mortality, which suggests a larger role for decreases in accessibility rather than decreases in healthcare quality as impact channels.
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Sánchez-Recio R, Alonso JP, Aguilar-Palacio I. The use of health care services in the Great Recession: evaluating inequalities in the Spanish context. GACETA SANITARIA 2020; 34:245-252. [PMID: 32005597 DOI: 10.1016/j.gaceta.2019.10.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 10/21/2019] [Accepted: 10/22/2019] [Indexed: 01/15/2023]
Abstract
OBJECTIVE To analyse the effect of the Great Recession (2008) on primary care (PC) and secondary care (SC) inequalities in Spain. METHOD Repeated cross-sectional study using Spanish Health Surveys from 2001 to 2017 (n=139,566). Prevalence of PC and SC utilization were calculated standardized by age. Chi square tests for trend were conducted to explore the evolution. We performed logistic regression analyses adjusted by the Andersen's model of demand for care to explore inequalities prior to, during and following the recession. All the analyses were stratified by sex. RESULTS Healthcare use trends changed from a rapid increase in the pre-recession period to a plateau during the recession and a decrease in the post-recession period. Healthcare use was higher in women (PC: 15.8% to 32.5%; SC: 8.2% to 16.2%) than in men (PC: 11.3% to 24.1%; SC: 5.4% to 11.6%) and the gender gap increased. During the recession the likelihood of PC use was higher in disadvantaged groups, while SC had greater usage amongst more advantaged social groups. Inequalities in SC use increased during the recession and could not be attributed to factors of need. CONCLUSIONS Healthcare use trends changed as a result of the recession. There are socioeconomic inequalities in the use of PC and SC in Spain, which increased in secondary care, during the recession and in the post-recession period. It is necessary to take into account socioeconomic determinants in health planning, in order to achieve equity in healthcare services.
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Affiliation(s)
- Raquel Sánchez-Recio
- Departamento de Fisiatría y Enfermería, Universidad de Zaragoza, Zaragoza, Spain; Grupo de Investigación en Servicios Sanitarios de Aragón (GRISSA) IIS Aragón, Zaragoza, Spain
| | - Juan Pablo Alonso
- Grupo de Investigación en Servicios Sanitarios de Aragón (GRISSA) IIS Aragón, Zaragoza, Spain; Dirección General de Salud Pública, Gobierno de Aragón, Zaragoza, Spain
| | - Isabel Aguilar-Palacio
- Grupo de Investigación en Servicios Sanitarios de Aragón (GRISSA) IIS Aragón, Zaragoza, Spain; Departamento de Microbiología, Medicina Preventiva y Salud Pública, Universidad de Zaragoza, Zaragoza, Spain; Departamento de Fisiatría y Enfermería, Universidad de Zaragoza, Zaragoza, Spain.
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Thompson K, Ophem JV, Wagemakers A. Studying the impact of the Eurozone's Great Recession on health: Methodological choices and challenges. ECONOMICS AND HUMAN BIOLOGY 2019; 35:162-184. [PMID: 31376735 DOI: 10.1016/j.ehb.2019.06.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 06/13/2019] [Accepted: 06/17/2019] [Indexed: 06/10/2023]
Abstract
Europe's Great Recession provides an opportunity to study the impact of increased financial insecurity on health. A number of studies explored the impact of the Recession on health, but they often reached different conclusions. To understand the root of this debate, we undertook a systematic literature review. Articles were analysed thematically based on: geography, data type, operationalisations of wealth and health, and study design. A critical appraisal was also undertaken. Forty-two studies, published from January 2010 to October 2018, were included in our review. Twenty-six of the forty-two studies found that the Great Recession worsened physical health indicators in the Eurozone. In terms of geography, a large concentration of studies focussed on Spain and Greece, indicating that there may be a gap in understanding the health consequences for EU countries with less severe experiences of the Recession. Regarding data type, nearly all studies used secondary datasets, possibly meaning that studies were constrained by the data available. In terms of operationalisations of wealth and health, a majority of studies used single/simple measures of both, so that these multi-faceted concepts were not fully reflected. Further, fewer than half included studies used panel data, with the remaining studies unable to undertake more causal analyses. The results of the critical appraisal showed that lower-quality studies tended to not find a negative impact of the Recession on health, whereas higher quality studies generally did. In future, we recommend conducting cross-country comparisons, using (inter)nationally-representative panel data conducted over a minimum of a ten-year time horizon, and employing multi-faceted operationalisations of wealth and health. This could provide more common ground across studies, and a clearer indication of whether the Recession impacted health.
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Affiliation(s)
- Kristina Thompson
- Department of Health Sciences, Vrije Universiteit Amsterdam, De Boelelaan 1085, 1081 HV Amsterdam, the Netherlands.
| | - Johan van Ophem
- Chair Group Urban Economics, Department of Social Sciences, Wageningen University and Research, Hollandseweg 1, 6706KN Wageningen, the Netherlands
| | - Annemarie Wagemakers
- Chair Group Health and Society, Department of Social Sciences, Wageningen University and Research, Hollandseweg 1, 6706KN Wageningen, the Netherlands
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Saez M, Barceló MA, Saurina C, Cabrera A, Daponte A. Evaluation of the Biases in the Studies that Assess the Effects of the Great Recession on Health. A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E2479. [PMID: 31336776 PMCID: PMC6678595 DOI: 10.3390/ijerph16142479] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 07/06/2019] [Accepted: 07/08/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND Our main objective was to evaluate the fundamental biases detected in studies assessing the effects the Great Recession had on health for the case of Spain. As secondary objectives we presented methods to control these biases and to discuss the results of the studies in question if they had controlled for them. METHODS We carried out a systematic review of the literature published up to June 2018. We evaluated the biases that could have happened in all the eligible studies. RESULTS From the review, we finally selected 53 studies. Of the studies we reviewed, 60.38% or 32 out of 53, were evaluated as having a high risk of bias. The main biases our review revealed were problems with evaluation, time bias, lack of control of unobserved confounding, and non-exogeneity when defining the onset of the Great Recession. CONCLUSIONS The results from the studies that controlled the biases were quite consistent. Summing up, the studies reviewed found that the Great Recession increased the risk of declaring poor self-rated health and the deterioration of mental health. Both the mortality rate and the suicide rate may well have increased after the Great Recession, probably after a three- to four-year delay.
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Affiliation(s)
- Marc Saez
- Research Group on Statistics, Econometrics and Health (GRECS), University of Girona, 17003 Girona, Spain.
- Network Biomedical Research Center of Epidemiology and Public Health (CIBERESP), 28029 Madrid, Spain.
| | - Maria Antònia Barceló
- Research Group on Statistics, Econometrics and Health (GRECS), University of Girona, 17003 Girona, Spain
- Network Biomedical Research Center of Epidemiology and Public Health (CIBERESP), 28029 Madrid, Spain
| | - Carme Saurina
- Research Group on Statistics, Econometrics and Health (GRECS), University of Girona, 17003 Girona, Spain
- Network Biomedical Research Center of Epidemiology and Public Health (CIBERESP), 28029 Madrid, Spain
| | - Andrés Cabrera
- Network Biomedical Research Center of Epidemiology and Public Health (CIBERESP), 28029 Madrid, Spain
- Andalusian School of Public Health, 18080 Granada, Spain
- Instituto de Investigación Biosanitaria (IBS), Hospital Universitario de Granada, Universidad de Granada, 18014 Granada, Spain
| | - Antonio Daponte
- Network Biomedical Research Center of Epidemiology and Public Health (CIBERESP), 28029 Madrid, Spain
- Andalusian School of Public Health, 18080 Granada, Spain
- Instituto de Investigación Biosanitaria (IBS), Hospital Universitario de Granada, Universidad de Granada, 18014 Granada, Spain
- Observatorio de Salud y Medio Ambiente de Andalucía (OSMAN), 18080 Granada, Spain
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Mazeikaite G, O'Donoghue C, Sologon DM. The Great Recession, financial strain and self-assessed health in Ireland. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2019; 20:579-596. [PMID: 30564918 PMCID: PMC6517350 DOI: 10.1007/s10198-018-1019-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Accepted: 12/04/2018] [Indexed: 06/09/2023]
Abstract
In this paper, we study the effects of the 2008 economic crisis on general health in one of the most severely affected EU economies-Ireland. We examine the relationship between compositional changes in demographic and socio-economic factors, such as education, income, and financial strain, and changes in the prevalence of poor self-assessed health over a 5-year period (2008-2013). We apply a generalised Oaxaca-Blinder decomposition approach for non-linear regression models proposed by Fairlie (1999, 2005). Results show that the increased financial strain explained the largest part of the increase in poor health in the Irish population and different sub-groups. Changes in the economic activity status and population structure also had a significant positive effect. The expansion of education had a significant negative effect, preventing further increases in poor health. Wealthier and better educated individuals experienced larger relative increases in poor health, which led to reduced socio-economic health inequalities.
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Affiliation(s)
- Gintare Mazeikaite
- Luxembourg Institute of Socio-Economic Research (LISER), Esch-Sur-Alzette, Luxembourg.
- Maastricht University/UNU-MERIT, Maastricht, Netherlands.
| | | | - Denisa M Sologon
- Luxembourg Institute of Socio-Economic Research (LISER), Esch-Sur-Alzette, Luxembourg
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Self-rated health status, health inequalities and economic crisis: the case of Spain. Salud Colect 2019; 14:671-674. [PMID: 30726441 DOI: 10.18294/sc.2018.1984] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Saez M, Vidiella-Martin J, Casasnovas GL. Impact of the great recession on self-perceived health in Spain: a longitudinal study with individual data. BMJ Open 2019; 9:e023258. [PMID: 30782700 PMCID: PMC6361339 DOI: 10.1136/bmjopen-2018-023258] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 08/10/2018] [Accepted: 09/27/2018] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVES Our objective in this study is to evaluate the impact the Great Recession (2008-2014) had on self-perceived health in Spain. DESIGN We use a longitudinal database (four waves of the Bank of Spain's Survey of Household Finances (2005, 2008, 2011 and 2014)) with repeated observations of the same individuals before and after the Great Recession. INTERVENTIONS We consider the Great Recession in a natural experiment and we introduce it as an explanatory variable in a mixed logistic regression model in which we explain the probability of a subject declaring poor health (fair, bad and very bad). In the model we control for both observed and unobserved confounders at both individual and family level. RESULTS We find an average downward trend in self-perceived health during the most severe period of the Great Recession (2009-2011). However, the fact that the adjusted measures are less volatile than the crude ones shows that variation in health status can be captured by either demographic or socioeconomic controls. In fact, there are significant differences in the impact the economic crisis had on health in terms of gender and age group. In particular, the (adjusted) risk of declaring poor health increases after the crisis began but only in those families in which the reference person is a woman younger than 45 years of age or a man aged 75 years or older. CONCLUSIONS Given our results, we discuss the link between financial wealth and self-rated health and how policy-makers could address the health inequalities that arise from adverse economic and financial shocks.
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Affiliation(s)
- Marc Saez
- Research Group on Statistics, Econometrics and Health (GRECS), University of Girona, Girona, Spain
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Center for Research in Health and Economics (CRES), Universitat Pompeu Fabra, Barcelona, Spain
| | - Joaquim Vidiella-Martin
- Erasmus School of Economics, Erasmus University Rotterdam, Rotterdam, The Netherlands
- Tinbergen Institute, Amsterdam, The Netherlands
| | - Guillem López Casasnovas
- Center for Research in Health and Economics (CRES), Universitat Pompeu Fabra, Barcelona, Spain
- Department of Economics and Business, Department of Economics and Business, Barcelona, Spain
- Barcelona Graduate School (BGSE), Universitat Pompeu Fabra, Barcelona, Spain
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Heggebø K, Tøge AG, Dahl E, Berg JE. Socioeconomic inequalities in health during the Great Recession: A scoping review of the research literature. Scand J Public Health 2018; 47:635-654. [DOI: 10.1177/1403494818801637] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Aims: The so-called ‘Great Recession’ in Europe triggered widespread concerns about population health, as reflected by an upsurge in empirical research on the health impacts of the economic crisis. A growing body of empirical studies has also been devoted to socioeconomic inequalities in health during the Great Recession. The aim of the current study is to summarise this health inequality literature by means of a scoping review. Methods: We have performed a scoping review of the research literature (English language) published in the years 2012–2017. Only empirical papers with (a) health status measured on the individual level, (b) information on socioeconomic position (i.e. employment status, educational level, income/wealth, and/or occupational class), and (c) data from European countries in both pre- and post-crisis years were considered relevant. In total, 49 empirical studies fulfilled these inclusion criteria. Results: The empirical findings in the 49 included studies predominantly show that socioeconomic inequalities in health either increased or remained stable from pre- to post-crisis years. Two-thirds (65%) of the studies found evidence of either increasing or partially increasing health inequalities. Thus, people in lower socioeconomic strata fared worse overall in terms of health during the Great Recession, compared to people with higher socioeconomic status. Conclusions: The Great Recession in Europe tends to be followed by increasing socioeconomic inequalities in health. Policymakers should take note of this finding. Widening socioeconomic inequalities in health is a major cause of concern, in particular if health deterioration among ‘vulnerable groups’ is caused by accelerating cumulative disadvantages.
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Affiliation(s)
| | - Anne Grete Tøge
- Work Research Institute (AFI), Oslo Metropolitan University, Norway
| | - Espen Dahl
- Department of Social Work, Child Welfare and Social Policy, Oslo Metropolitan University, Norway
| | - John Erik Berg
- Department of Occupational Therapy, Oslo Metropolitan University, Norway
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Welfare states, the Great Recession and health: Trends in educational inequalities in self-reported health in 26 European countries. PLoS One 2018; 13:e0193165. [PMID: 29474377 PMCID: PMC5825059 DOI: 10.1371/journal.pone.0193165] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Accepted: 02/06/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Although socioeconomic inequalities in health have long been observed in Europe, few studies have analysed their recent patterning. In this paper, we examined how educational inequalities in self-reported health have evolved in different European countries and welfare state regimes over the last decade, which was troubled by the Great Recession. METHODS We used cross-sectional data from the EU-SILC survey for adults from 26 European countries, from 2005 to 2014 (n = 3,030,595). We first calculated education-related absolute (SII) and relative (RII) inequalities in poor self-reported health by country-year, adjusting for age, sex, and EU-SILC survey weights. We then regressed the year- and country-specific RII and SII on a yearly time trend, globally and by welfare regime, adjusting for country fixed effects. We further adjusted the analysis for the economic cycle using GDP growth, unemployment, and income inequality. RESULTS Overall, absolute inequalities persisted and relative inequalities slightly widened (betaRII = 0.0313, p<0.05). There were substantial differences by welfare regime: Anglo-Saxon countries experienced the largest increase in absolute inequalities (betaSII = 0.0032, p<0.05), followed by Bismarkian countries (betaSII = 0.0024, p<0.001), while they reduced in Post-Communist countries (betaSII = -0.0022, p<0.001). Post-Communist countries also experienced a widening in relative inequalities (betaRII = 0.1112, p<0.001), which were found to be stable elsewhere. Adjustment for income inequality only explained such trend in Anglo-Saxon countries. CONCLUSIONS Educational inequalities in health have overall persisted across European countries over the last decade. However, there is considerable variation across welfare regimes, possibly related to underpinning social safety nets and to austerity measures implemented during this 10-year period.
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Palacios-Ceña D, Hernández-Barrera V, Jiménez-Trujillo I, Serrano-Urrea R, Fernández-de-Las-Peñas C, Carrasco-Garrido P. Time trends in antibiotic consumption in the elderly: Ten-year follow-up of the Spanish National Health Survey and the European Health Interview Survey for Spain (2003-2014). PLoS One 2017; 12:e0185869. [PMID: 29186144 PMCID: PMC5706724 DOI: 10.1371/journal.pone.0185869] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Accepted: 09/20/2017] [Indexed: 11/26/2022] Open
Abstract
Background The purposes of this study were: firstly, to estimate time trends in the prevalence of prescription antibiotic consumption between 2003 and 2014; secondly, to identify the factors associated with the probability of consuming antibiotics during this period in elderly persons in Spain. Methods We analyzed data collected from the Spanish National Health Survey in 2003 (n = 21,650), 2006 (n = 29,478), and 2012 (n = 20,007) and from the European Health Interview Survey for Spain in 2009 (n = 22,188) and 2014 (n = 22,842). Antibiotic consumption was the dependent variable. We also analyzed sociodemographic features, self-perceived health status, lifestyle habits, comorbid diseases, and disabilities using logistic regression models. Results The prevalence of antibiotic consumption increased from 2003 to 2014 in both sexes. The variables that predicted antibiotic consumption (men; women) were secondary education (OR 1.38; OR 1.31), visits to a general practitioner (OR 2.05; OR 2.15), hospitalization (OR 1.91; OR 1.83), therapy with > 4 non-antibiotic drugs (OR 3.36; OR 5.84), instrumental activities of daily living (OR 1.50; OR 1.24), and activities of daily living (OR 1.39; OR 1.35). In contrast, age > 85 years was associated with low antibiotic consumption in both men (OR 0.81) and women (OR 0.88). Conclusions The prevalence of antibiotic prescription has increased in Spain in the last decade. Our study identified several factors that appear to affect antibiotic consumption in elderly persons, with potential implications for healthcare providers.
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Affiliation(s)
- Domingo Palacios-Ceña
- Department of Physiotherapy, Occupational Therapy, Rehabilitation and Physical Medicine. ITPSE Research Group. Universidad Rey Juan Carlos. Alcorcón, Madrid. Spain
| | - Valentín Hernández-Barrera
- Medicine and Surgery, Psychology, Preventive Medicine and Public Health, Medical Microbiology and Immunology and Nursing Department. Universidad Rey Juan Carlos. Alcorcón, Madrid
| | - Isabel Jiménez-Trujillo
- Medicine and Surgery, Psychology, Preventive Medicine and Public Health, Medical Microbiology and Immunology and Nursing Department. Universidad Rey Juan Carlos. Alcorcón, Madrid
| | - Ramón Serrano-Urrea
- Department of Mathematics. Faculty of Computer Science Engineering. University of Castilla-La Mancha. Albacete, Castilla la Mancha. Spain
| | - César Fernández-de-Las-Peñas
- Department of Physiotherapy, Occupational Therapy, Rehabilitation and Physical Medicine. ITPSE Research Group. Universidad Rey Juan Carlos. Alcorcón, Madrid. Spain
| | - Pilar Carrasco-Garrido
- Medicine and Surgery, Psychology, Preventive Medicine and Public Health, Medical Microbiology and Immunology and Nursing Department. ITPSE Research Group. Universidad Rey Juan Carlos. Alcorcón, Madrid. Spain
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Lopez-Valcarcel BG, Barber P. Economic Crisis, Austerity Policies, Health and Fairness: Lessons Learned in Spain. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2017; 15:13-21. [PMID: 27461007 DOI: 10.1007/s40258-016-0263-0] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
This paper reviews economic and medical research publications to determine the extent to which the measures applied in Spain to control public health spending following the economic and financial crisis that began in 2008 have affected healthcare utilization, health and fairness within the public healthcare system. The majority of the studies examined focus on the most controversial cutbacks that came into force in mid-2012. The conclusions drawn, in general, are inconclusive. The consequences of this new policy of healthcare austerity are apparent in terms of access to the system, but no systematic effects on the health of the general population are reported. Studies based on indicators of premature mortality, avoidable mortality or self-perceived health have not found clear negative effects of the crisis on public health. The increased demands for co-payment provoked a short-term cutback in the consumption of medicines, but this effect faded after 12-18 months. No deterioration in the health of immigrants after the onset of the crisis was unambiguously detected. The impact of the recession on the general population in terms of diseases associated with mental health is well documented; however, the high levels of unemployment are identified as direct causes. Therefore, social policies rather than measures affecting the healthcare system would be primarily responsible. In addition, some health problems have a clear social dimension, which seems to have become more acute during the crisis, affecting in particular the most vulnerable population groups and the most disadvantaged social classes, thus widening the inequality gap.
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Affiliation(s)
- Beatriz G Lopez-Valcarcel
- Department of Quantitative Methods for Economics and Management, University of Las Palmas de Gran Canaria, Campus Tafira, 35320, Las Palmas de Gran Canaria, Spain.
| | - Patricia Barber
- Department of Quantitative Methods for Economics and Management, University of Las Palmas de Gran Canaria, Campus Tafira, 35320, Las Palmas de Gran Canaria, Spain
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Solé-Auró A, Alcañiz M. Educational attainment, gender and health inequalities among older adults in Catalonia (Spain). Int J Equity Health 2016; 15:126. [PMID: 27491677 PMCID: PMC4973518 DOI: 10.1186/s12939-016-0414-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Accepted: 07/28/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Health expectancies vary worldwide according to socioeconomic status (SES), with health disadvantages being evident among lower SES groups. Using educational attainment as a proxy of SES, we seek to identify trends in SES differentials in health by gender, with a particular focus on individuals with low educational attainment in the adult Catalan population (Spain) aged 55 or older. METHODS Using cross-sectional data for 1994 and 2010-2014 drawn from the Catalan Health Survey, we examined three health indicators to document social health inequalities: self-perceived health, functional limitations, and restrictions on activities of daily living (ADL). We applied logistic models for each indicator, controlling for sociodemographic characteristics, health coverage and health behaviours. RESULTS Among the less-educated, females presented a greater improvement in their self-perceived health over time than did their male counterparts, there being no significant variations among the medium/high educated. Regardless of education, males showed an increase in the prevalence of functional problems (as did the women, but the increase was not statistically significant). Both genders presented a higher prevalence of limitations when performing ADL in the second time period. The gender health gap was reduced slightly both for the low and the medium/high educated, expect in the case of ADL restrictions. Health and functioning differences by education level persisted, but showed significant signs of reduction. CONCLUSIONS Less-educated females constitute the most disadvantaged group in terms of health and personal autonomy, though there are encouraging signs that the gap is closing both in terms of gender and level of education. Health policymakers need to devote particular attention to the aging population with low SES, especially to women. Public programmes promoting greater protection and equity, while fostering preventive and healthy practices, need to target the most underprivileged.
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Affiliation(s)
- Aïda Solé-Auró
- Department of Political and Social Sciences, Universitat Pompeu Fabra, C/ Ramon Trias Fargas, 25-27, 08005 Barcelona, Spain
| | - Manuela Alcañiz
- Riskcenter, Department of Econometrics, Statistics and Applied Economy, University of Barcelona, Av. Diagonal 690, 08034 Barcelona, Spain
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